"Take the HIV fight to them."

Take the HIV/AIDS fight to them, Former President Nelson Mandela urged as we were leaving: ‘Nothing that we have achieved in our country was without a fight. But I am too old now. You scientists must pick it up’ he remarked to his fellow Nobel Laureate David Baltimore.

Likely one of the most pre-eminent biologists specialising in viruses today, Baltimore briefed an obviously fascinated Mandela on what we know about the Human Immuno-deficiency Virus (HIV). It was a breathtaking preview of the full Nelson Mandela Science Lecture he was to give an hour later at WITS.

No spring chicken himself, Baltimore at 69 stepped off the flight that some morning, after two 11 hour-long flights from California. Most of us would wilt at the thought of such a travel schedule. None of this diminished the sharp edge of his intellect obvious to everyone who attended his lecture.

A virus is of course the simplest form of life on earth. It is microscopic, pared down, incapable though of carrying life processes on its own: ‘it must find its way into a living cell where it commandeers the machinery it needs to multiply itself’ says Baltimore.

There are equilibrium and non-equilibrium viruses. Equilibrium viruses are well adapted to the host species and really have nowhere else to go. Polio, smallpox, measles and mumps are equilibrium viruses in humans and because they have nowhere else to go, they are targets for effective elimination.

Non-equilibrium viruses are not well adapted to the host species. These are the ones – like the various flu viruses involving birds and pigs – that cause havoc (see John Farndon’s Bird Flu, Cambridge, 2005). Ebola virus is a stable equilibrium one in bats, their source, but is lethal when it infects humans.

Similarly, the immuno-deficiency virus (IV) is equilibrium one in simian monkeys, its source, but deadly when it comes to human beings. We though reached the stage in medicine where it can, with anti-retroviral drugs, be considered a treatable and managed condition, like diabetes.

In her book The Invisible Enemy: A Natural History of Viruses, Dorothy Crawford writes about how our heavily populated and settled world of human beings and animals create conditions for new viruses or old ones reappearing to emerge and thrive (Oxford University Press, 2000).

Viruses threaten not only humans, but also animals, says Baltimore: ‘Bees are dying throughout the world, apparently of a virus infection that was first detected in Israel but may have originated in Australia. And pigs in China are dying with blue ears in large numbers’ because a virus is deoxygenating the blood flowing there.

HIV is just another non-equilibrium virus in the human population. But it has some deadly characteristics. Unusually, it does not hide away but swims in the bloodstream. The machine that clears viruses out of the bloodstream – the immune system – just cannot do it in the case of HIV.

Typically, the immune system, which has two arms, figures out a way of identifying foreign bugs, designs and then produces an envelop to wrap itself around it and squeezes the damn thing as if, as Shakespeare put it in Henry V, they ‘are marked to die’ (act 4, sc.3 1.20).

HIV, though, completely ‘neuters the immune system. It is actually unprecedented’ says Baltimore. The best way to stop it is by prevention, but all efforts at vaccine development have thus far failed. Recently, the Merck pharmaceutical company reported that a promising vaccine miserably failed the first round of clinical trials.

Baltimore went from the lecture to participate in the Gates Foundation meetings that in part dealt with vaccine development. The conclusion there, with all the money, expertise and will a vaccine is still ten years away. ‘The implication for South Africa’ Baltimore urges ‘is that our only hope to blunt the spread of HIV at this time is education.’

Educational advice that condoms must be used and syringes handed out free to intravenous drug users. ‘These are not difficult or even very expensive actions. However, they take honest educational advice, spread to everyone in the population and having the impramatur of the highest authorities in the country.’

Mandela’s plea to not sit back but take the fight to them is combating ignorance wherever and whenever it is evident. The Treatment Action Campaign has certainly taken the fight to them. It is time that everybody else who cares about our country take the fight to those who spread lies, superstitious nonsense and quackery.